Information Collection Requirements Contained in BDP-718: Advanced Directives (Medicare and Medicaid) and Supporting Regulations in 42 CFR Sections 417.436, 417.801, 422.128,....

ICR 200205-0938-007

OMB: 0938-0610

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0610 200205-0938-007
Historical Active 199903-0938-005
HHS/CMS
Information Collection Requirements Contained in BDP-718: Advanced Directives (Medicare and Medicaid) and Supporting Regulations in 42 CFR Sections 417.436, 417.801, 422.128,....
Extension without change of a currently approved collection   No
Regular
Approved without change 07/08/2002
Retrieve Notice of Action (NOA) 05/10/2002
  Inventory as of this Action Requested Previously Approved
07/31/2005 07/31/2005 07/31/2002
34,365 0 35,905
960,500 0 908,250
0 0 0

Medicare/Medicaid Advance Directives. Certain Medicare and Medicaid organizations are responsible for collecting and documenting in a prominent place in medical records weather and individual has executed an advanced directive. This document indicates the individual's preferences if he/she is incapacitated.

None
None


No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 34,365 35,905 0 0 -1,540 0
Annual Time Burden (Hours) 960,500 908,250 0 0 52,250 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/10/2002


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